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RESEARC H Open Access
Revisiting Lynam’s notion of the “fledgling
psychopath": are HIA-CP children truly
psychopathic-like?
Jared D Michonski, Carla Sharp
*
Abstract
Background: In his developmental model of emerging psychopathy, Lynam proposed that the “fledgling
psychopath” is most likely to be located within a subgroup of children elevated in both hyperactivity/inattention/
impulsivity (HIA) and conduct problems (CP). This approach has garnered some empirical support. However, the
extent to which Lynam’s model captures children who resemble psychopathy with regard to the core affective and
interpersonal features remains unclear.
Methods: In the present study, we investigated this issue within a large community sample of youth (N = 617).
Four groups (non-HIA-CP, HIA-only, CP-only, and HIA-CP), defined on the basis of teacher reports of the Strengths
and Difficulties Questionnaire (SDQ), were compared with respect to parent-reported psychopathic-like traits and
subjective emotional reactivity in response to unpleasant, emotionally-laden pictures from the International
Affective Pictures System (IAPS).
Results: Results did not support Lynam’s model. HIA-CP children did not appear most psychopathic-like on
dimensions of callous-unemotional and narcissistic personality, nor did they report reduced emotional reactivity to
the IAPS relative to the other children. Post-hoc regression analyses revealed a significant moderation such that
elevated HIA weakened the association between CP and emotional underarousal.
Conclusions: Implications of these findings with regard to the development of psychopathy are discussed.
Background
A growing literature has sought to extend the psychopa-
thy construct to youth [1-4]. In one appro ach to doing
so, Lynam [1] proposed lo cating the future psychopath
within the current childhood diagnostic nomenclature.
He hypothesized that children h igh in both hyperactiv-
ity, inattention, and impulsi vity (HIA), as exemplified in
attention deficit/hyperactivity disorder (ADHD), and
conduct probl ems (CP), as exemplifi ed in a diagnosis of

oppositional defiant disorder (ODD) or conduct disorder
(CD), define a subgroup afflicted with a particularly
virulent strain of conduct disorder–what he described as
“fledglin g psychopathy.” Inasubsequenttestofhis
model, Lynam [5] found initial support for his predic-
tions. Categorizing a high-risk sample of boys into four
groups as a function of their standing on HIA and CP,
Lynam found that boys high in both HIA and CP could
be reliably distinguishe d from the other boys (low HIA/
low CP, H IA-onl y, and CP-only) using measures of psy-
chopathic personality, antisocial behavior, and laboratory
tasks designed to assess difficulty in delay of gratification
and response modulation.
Lynam’s [1] model is interesting in that, although he
proposes that children elevated in both HIA and CP
should most resemble the personality of psychopaths,
his model seemingly places little emphasis upon those
traits generally regarded as most central to the psycho-
pathy construct [6]. Most definitions of psychopathy
draw upon the interpersonal-affec tive features of psy-
chopathy first described by Cleckley [7] to include char-
acteristicssuchassuperficial charm, egocentricity,
dishonesty, shallow affect, and lack of remorse.
Consistent with definitions of psychopathy highlight-
ing diminished affective experience, a number of studies
have found reduced emotional reactivity to and
* Correspondence:
Department of Psychology, 126 Heyne Building, Houston, Texas, 77204, USA
Michonski and Sharp Child and Adolescent Psychiatry and Mental Health 2010, 4:24
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Commons Attribution License (ht tp://creativecomm ons.org/licenses/by/2.0), which permits unrestricted use, distri butio n, and
reproduction in any medium, provided the original wor k is properly cited.
processing of negative emotional stimuli in adult psy-
chopaths and in children with psychopathic-like traits.
In adults, psychopathy has been associated with reduced
autonomic activity to negatively valenced stimuli, as
measured via skin conduct ance (SC) [8] and, perhaps in
particular, reduced responsivity to distress cues [9-11].
In child studies, psychopath ic-like traits have been asso-
ciated with reduced SC responses to cues of distress and
threat [12], as well as reduced SC to aversive white
noise [13]. Furthermore, in adults, psychopathy–specifi-
cally the affective and interpersonal features–have been
linked to reduced fear response as measured via eye-
blink startle reflex, both in criminal [14,15] and commu-
nity samples [16]. Psychopathic-like traits have also been
associated with reduced cognitive-affective processing of
negative emotional s timuli, as evidence by reduced
attentional orienting to negative emotional words
[17,18] and distressing pictures [19], as well as reduced
recognition of facial displays of distress [20,21], sad
vocal tones [21], and self-report of reduced emotional
reactivity in response to emotionally intense and unplea-
sant pictures [22].
In contrast, Lynam’s method for locating the fledgling
psychopath (HIA-CP) appea rs to place primary empha-
sis upon the impulsive, irresponsible, stimulation-seek-
ing (behavioral) dimension of psychopathy. An
important question, however, is whether children high
in HIA and CP exhibit the characteristic affective and

interpersonal features of psychopathy. Researc h has well
established that the combination of HIA and CP consti-
tutes a particularly at-risk subgroup of aggressive youth,
more so than HIA-only or CP-only children [23,24].
However, few studies have explicitly tested Lynam’s[1]
prediction that HIA-CP children look the most psycho-
pathic in terms of their personality. In his empirical
investigation of his model, Lynam [5] found that the
HIA-CP group was higher than the other groups in psy-
chopathic-like traits, as measured by mother reports on
the Childhood Psychopathy Scale (CPS), b ut the differ-
ence relative to the CP-only group was nonsi gnificant.
Barry et al. [25] employed Lynam’s groupings, designat-
ing a group of children who met criteria for ADHD and
ODD/CD, another who met criteria for ADHD but not
for ODD/CD, and a third group consisting of clinic-
referred controls who did not meet criteria for ADHD
or ODD/CD (an ODD/CD only group was not included
due to insufficient sample size). Of note, Barry et al.
[25] compared the groups of children on teacher reports
of the core affective /interpersonal features of psychopa-
thy and found that the ADHD-ODD/CD group had a
significantly higher proportion of children elevated on
callous-unemotional (CU) traits than both the ADHD
only and clinical control group. Retrospective repor ts of
adult psychopaths also provide support for Lynam.
Johansson, Kerr, and Andershed [26] found that psycho-
pathiccriminalswereconsiderablymorelikelythan
non-psychopathic criminals to report childhood histories
of CP and HIA.

Further support for Lynam’s approach comes from
studiesconsideringthespecificroleofADHDinpro-
motin g psycho pathic traits. Fowler et al. [27] found that
their sample of ADHD children exhibited higher total
psychopathic traits, and affective traits (as measured by
the PCL-R [28]) in particular, compared to a community
sample of adolescents. Piatigorsky & Hinshaw [29]
reported similar findings: ADHD boys were significantly
more psychopathic-like than control boys. This differ-
ence remained even after controlling for ODD status,
indicating that ADHD exerted a unique effect upon psy-
chopathy ratings.
These studies provide some initial support for Lynam’s
[1] proposal. However, the number of attempts to test
Lynam’s model is still relatively few. In the present
study, we seek to revisit Lynam’s model for locatin g the
fledgling psychopath in the current childhood diagnostic
nomenclature. In particular, we are interested in how
Lynam’s group designations compare with respect to the
affective/interpersonal features of the construct. If
Lynam’s model is sufficient to identify children most
resembling adult psychopaths, then t he following
hypothes es should be supported: First, children elevated
in teacher-reported HIA and CP should be rated by par-
ents as more psychopathic-like on the Antisocial Process
Screening Devise (AP SD) [30]thancomparisongroups
(no problems, HIA-only, and CP-only). More specifi-
cally, the HIA-CP group should exhibit greater affective/
interpersonal ( callous-unemotional) traits, not just ele-
vated scores on the total or impulsivity dimension. Sec-

ondly, HIA-CP children should report reduced
emotional reactivity in respons e to unpleasant emotion-
ally-laden pictures (International Affective Picture Sys-
tem) [31] than the comparison groups. Given that this
study employed multiple sources of report (parent
report of psychopathic traits, teacher report of conduct
and hyperactivity problems, and self-report of emotional
reactivity) support for the above hypotheses cannot be
attributed to shared method variance and is therefore a
strength of the current study.
Methods
Participants
The present study was a part of a larger investigation of
social-cognitive and emotional correlates of antisocial
behavior in a large communit ysampleofchildren(the
Child Behavior Study). Participants consisted of 2,950 7
to 11 year-old children recruited from 16 primary
schools in Cambridgeshire, England. Of the parents con-
tacted, an average of 22% granted consent for their
Michonski and Sharp Child and Adolescent Psychiatry and Mental Health 2010, 4:24
/>Page 2 of 9
child’s participation. The response rates for individual
schools ranged f rom 14 to 40%. A total of 659 children
(319 boys and 340 girls) were initially enrolled. After
removal of children with incomplete data, this number
was reduced to 617 in the current analysis.
In order to examine the generalizab ility of findings,
the school board’s permission was asked so that teachers
from one of the schools anonymously completed a
population-based screen of psychiatric problems (the

Strength s and Difficulties Questionnaire (SDQ) [32]) on
all children, allowing for comparison of children whose
families did not consent to participate with those who
did. Of note, no significant differences were present
across all five subscales of the SDQ. Secondly, compari-
son of sociodemographic characteristics of the sample of
participants to regional statistics revealed no evidence of
selection bias. The ethnic distribution i n the sample was
in line with regional statistics for Eastern England (97%
White, 2% Asian, 0.5% Black and 0.5% Oriental) and
comprised of 40% wealthy achievers, 9% urban prosp er-
ity, 28% comf ortabl y well-off, 9% mode rate means, and
14% hard pressed. The mean age and IQ for children
participating in the present s tudy was 9.6 (SD =1.22)
and 104 (SD = 17), respectively.
Measures
Teacher-reported hyperactivity and conduct problems
Parents and teachers completed the Strengths and Diffi-
culties Questionnaire (SDQ) [32]. The SDQ is a 25-item
behavioral screening measure that was designed to pro-
vide a brief assessment of child psychiatric disorders in
children ages 3 to 16. Despite its brevity, the SDQ has
been shown comparable to the much longer Child Beha-
vior Checklist (CBCL) [33] in assessing internalizing and
externalizing problems and may be better than the
CBCL in detecting inattention and hyper activity [34].
The SDQ produc es five subsc ales, four of which mea-
sure psychopathology: emotionality, conduct problems,
hyperactivity/inattention, and peer problems. The
remaining subscale measures prosocial behavior. The

five subscales demonstrate adequate internal reliability,
particularly teacher report (used in the current study).
Cronbach’s a has been found to range from .70 (peer
problems) to .88 (hyperactivity/inattention) for teacher
report [35]. In the current study, Cronbach’s a was .89
(hyperactivity/inattention) and .73 (conduct problems)
for the two teacher-reported subscales used. The SDQ
has been shown to accurately detect psychiatric diag-
noses in community [36,37] and clinical samples [38]. It
has demonstrated a specific ity of 94.6% (95% CI 94.1-
95.1%) and a sensitivity of 63.3% (59.7-66.9%) in identi-
fying psychiatric diagnosis, and performed particularly
well with regard to conduct-oppositional disorders and
hyperactivity disorders (sensitivity ranging from 70-90%)
[36]. Due to its success, it has now been translated into
over 60 languages and it is being used all o ver the
world.
Parent-reported psychopathic personality traits
The Antisocial Process Screening Device [30] is a 20-
item behavioral rating scale used to assess psychopathic-
like traits in youth. Factor analytic studies have generally
revealed three dimensions: a 7-item narcissism factor, a
5-item impulsivity factor, and a 6-item callous-unemo-
tional (CU) factor, with moderate correlations among
the factors [39-41]. Frick et al. [40] reported internal
consistenc ies rangi ng from .74 (impulsivity) to .83 (nar-
cissism); however, subsequent studi es have typically
found lower internal reliabilities, especi ally for the CU
subscale [39,42]. Cronbach’s a for parent reports in the
present study was .81 for the total APSD, with values of

.52 (CU), .64 (impulsivity), and .67 (narcissism) for t he
subscales. One promising approach to improve the psy-
chometric properties of the CU scale that has bee n used
in a number of studies [e.g., [39,43,44]] combines it ems
from the prosocial behavior scale of the SDQ with the
best-performing items of the APSD CU scale [see [39]].
We adopted this approach to measure CU traits in the
present study. Specifically, CU traits were computed as
the sum of three APSD CU items (unconcerned about
others’ feelings;lackofguilt;breakspromises)andfive
SDQ Prosocial items, reverse coded (considerate of
other’s feelings; shares with other children; helpful if
someone is hurt, upset, or ill; kind to younger children;
volunteers to help others). This composite CU scale
improved the internal reliability to . 78 in the present
sample.
Emotional reactivity
To measure subjective emotional reactivity, the Interna -
tional Affective Pictures System (IAPS) [31] was used.
The IAPS has a long tradition in the adult literature and
has recently been applied to samples of young children
[e.g. [22,45,46]] based on norms proved by Lang and
colleagues for the 7-11 year age range [31]. These stu-
dies have demonstrated validity for this measure in
young samples for use in community studies [45] and in
relation to psychopath ic-like traits and conduct pro-
blems [22]. For instance, in the original validation study
of the IAPS as used in t he current study, Sharp, Van
Goozen and Goodyer [22] showed that the IAPS could
elicit similar responses across a wide range of affective

content and with simila r gender differences as pre-
viously found in adults.
The same 27 pictures used in the Sharp, Petersen and
Goodyer [46] study were used here. Pictures varied with
respect to valence and arousal. All pictures were mounted
as A4 photographs in color, with high figure/ground con-
trast in order to ease discriminati on of relevan t features.
Pictures were selected for age-appropriateness. In keeping
Michonski and Sharp Child and Adolescent Psychiatry and Mental Health 2010, 4:24
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with research that investigates reduced emotional reactiv-
ity associated with externalizing disorders [22], only high
arousal/negatively valenced pictures were considered in
the present study. Although valence and arousal were both
rated for these pictures, only arousal ratings were used for
analyses, as valence ratings showed no relation to psycho-
pathic-like traits. To subjectively report their emotional
reactions, children used a paper-and-pencil version of the
Self-Assessment Manikin (SAM) [47]. This i s a child-
friendly approach that enables children to make dimen-
sional ratings of arousal on a 9-point scale with 1 indicat-
ing low arousal and 9 indicating high arousal. This
approach has been shown to yield valid responses in chil-
dren [22,45]. For determining indices of arousal, we fol-
lowed standard convention in using IAPS subjective
ratings [22,45] and calculated the mean of arousal ratings
to unpleasant, pleasant and neutral pictures respectively.
IQ
A shortened version (Vocabulary and Block Design) of
the Wechsler Intelligence Scale for Children [48] was

individually administered to children. This shortened
method has been validated to be an adequate measure
of IQ [49]. Sattler’s[49]guidelineswereusedtoscore
the measure.
Socio-economic status
To determine socio-economic status, we used a geode-
mographic tool called ACORN which is freely available
on the internet. ACORN categorizes all 1.9 million UK
postcodes, which have been described using o ver 125
demographic statistics within England, Scotland, Wales
and Northern Ireland, and 287 lifestyle variables, making
it a powerful discriminator for social class. For our pur-
poses we used ACORN’s 5-class system to determine
membership to one of the following: 0 for Wealthy
Achievers, 1 for Urban Prosp erity, 2 for Comfortably
Well Off, 3 for Moderate Means and 4 for Hard
Pressed.
Procedures
The first step in recruitment and consent procedures
involved contacting head teachers in the Cambridge
area. For those head teachers who consented, i nforma-
tion packets and consent forms were delivered to be
passed on to children and parents. Our research team
did not have access to names and contact details of par-
ents or children prior to consent. Postal informed con-
sent was obtained from all parents and child assent was
obtained in person prior to data collection. Children
and parents were told that the study was about under-
standing behavior problems in children, and the factors
that may influence behavior problems in children. Since

the Child Behavior Study focus es mostly on social cog-
nitive and affective processing correlates of antisocial
behavior, children were told that the study was about
unders tanding behavior problems and how thinking and
feeling affected behavior. Approval was also sought and
obtained from the local ethics committee prior to data
collection.
The administration of the IAPS and IQ testing took
place individually in a quiet room at school with ade-
quate lighting. The IAPS photographs were mounted on
a stand and shown for 10 seconds with 10-second inter-
vals between photographs. As suggested by the manual,
children were trained to use the SAM on a practice
trial. Following McManis et al.’s [45] work with pre-ado-
lescent children, words like happy, pleased, or good, and
unhappy, scared, angry, bad or sad were used in the
instructions to describe the endpoints of the pleasur e
(valence) scales. Words like calm, relaxed, bored, or
sleepy and excited, nervous or wide-awake described the
endpoints for the arousal scale.
Teachers were consulted as to the level of understand-
ing for the 7-year-olds (youngest cohort) of all question-
naire measures, and it was decided that questions would
be read aloud to this group for the self-report measures.
Care was taken not to influence children’sanswersin
any way. Children in higher grades were invited to ask
for help if needed. However, none of the children in the
high grades did so. Questionnaires were administered
individually and in private with children in an empty
classroom. Parent reports were obtained through mail.

Teacher report was obtained during the period of
assessment in a particular school.
Group Designation and Data Analytic Strategy
Groups were formed on the basis of teacher reports on
the hyperactivity (HIA) and conduct problems (CP)
scales from the SDQ. The clinical cutoffs developed and
normed by the developers of the SDQ http://www.
sdqinfo.com were used to identify children high in HIA
and/or CP. Means and standard deviations for teacher
reports of hyperactivity and conduct problems for each
of the four groups appear in Table 1. Each group dif-
fered significantly from one another in hyperactivity and
conduct problems. As to be expected, both HIA groups
wereratedasmorehyperactivethantheCP-onlyand
non-HIA-CP groups. Similarly, both CP groups were
rated as exhibiting more conduct problems than the
HIA-only and non-HIA-CP groups. Groups were also
compared on variables that have been shown to corre-
late with externalizing problems (age, gender, and IQ).
Because groups differed with respect to gender composi-
tion and IQ, these v ariables were considered as
covariates.
To test each hypothesis, we conducted a set of three
planned, pairwise comparisons, whereby each group was
compared to the HIA-CP group. The first contrast
(Cont. 1) tested the non-HIA-CP group against the
Michonski and Sharp Child and Adolescent Psychiatry and Mental Health 2010, 4:24
/>Page 4 of 9
HIA-CP group; the second contrast (Cont.2)testedthe
HIA-only group against the HIA-CP group; and the

third contrast (Cont. 3) c ompared the CP-only group
against the HIA-CP group. Type I error rate was main-
tained at a = .05 for testing each dependent variable
using Dunnett’s procedure.
Results
Psychopathic Traits
To test our first aim of whether the subgroup of con-
duct problem children identified by Lynam constitutes
the “fledgling psychopath,” we compared the four
groups on parental ratings of child psychopathic person-
ality traits (APSD). As Table 2 displays, planned con-
trasts revealed that the HIA-CP group appeared the
most psychopathic-like with respect to parental report
of APSD total score. The HIA-CP group was rated as
sig nificantly higher than all other groups, albeit the dif-
ference between the CP-only and HIA-CP groups
reached significance only for a 1-tailed test
1
.
Specific hypotheses were also tested with regard to the
narcissism, impulsivity, and CU subscales. We were par-
ticularly interested in testing whether Lynam’sfledgling
psychopathy group would be rated highest on the core
affective/interpersonal traits of psychopathy (CU
subscale). As shown in Table 2, the HIA-CP was consis-
tently higher than the other groups across each subscale,
but not all of these differences reached significance. The
HIA-CP group was significantly higher than the non-
HIA-CP and HIA-only groups for narcissism, impulsiv-
ity, and CU traits. How ever, the contrasts between the

HIA-CP and CP-only groups revealed that the higher
scores for the HIA-CP group were significant only for
the impulsivity subscale
2
.
Emotional Reactivity to Unpleasant Pictures
Conceptually, both CU traits and reduced reactivity to
negative emotional stimuli are important indicators of
psychopathy. Thus, one would expect the two criteria to
be significantly associated–specifically, to be negatively
correlated–such that higher CU traits correspond to
decreased arousal ratings. As expected, parent-report of
CU traits and self-reported arousal ratings to the nega-
tive emotional pictures were significantly negatively cor-
related, albeit the effect was small (r = 10, p < .05).
To test our second aim, we compared the four groups
on subjective emotional reactivity to unpleasant pictures.
As shown in Table 2, and contrary to expectations, none
of the planned contrasts examining group differences in
relation to the HIA-CP group were significant. HIA-CP
Table 1 Mean Scores of Four Comparison Groups on Demographic and HIA-CP Variables
Non-HIA-CP
(n = 517)
HIA-only
(n = 48)
CP-only
(n = 23)
HIA-CP
(n = 29)
Variable M (SD) M (SD) M (SD) M (SD)

Demographics
Age 9.60 (1.20) 9.37 (1.16) 9.73 (1.29) 9.36 (1.27)
Gender (% male) 45.26
a
62.50
b
52.17
a,b
65.52
b
IQ 106.30
a
(16.13) 97.90
b
(19.58) 101.35
a,b
(20.24) 92.81
b
(14.22)
SDQ (Teacher)
Hyperactivity 1.66
a
(1.91) 8.10
b
(0.99) 3.52
c
(2.08) 8.97
d
(1.12)
Conduct Problems 0.42

a
(0.80) 1.71
b
(0.99) 4.39
c
(0.58) 5.52
d
(1.62)
Note. Means with different subscripts differ significantly at p < .05. SDQ = Strength and Difficulties Questionnaire.
Table 2 Mean Scores on Measures of Psychopathic Traits and Emotional Reactivity to Unpleasant Pictures by HIA-CP
Group Designation
non-HIA-CP HIA-only CP-only HIA-CP t-values
Variable M (SD) M (SD) M (SD) M (SD) Cont. 1 Cont. 2 Cont. 3
Psychopathy (Total) 8.40 (4.49) 10.42 (4.13) 12.12 (5.30) 15.50 (6.95) 6.72*** 3.88*** 2.22
†
Narcissism 2.24 (1.97) 2.30 (1.65) 3.18 (1.59) 4.20 (2.91) 4.32*** 3.37** 1.56
Impulsivity 3.64 (1.82) 4.85 (1.68) 4.76 (1.75) 6.20 (2.19) 6.15*** 2.62* 2.39*
Callous-Unemotional 3.00 (2.56) 3.87 (2.64) 4.27 (3.03) 5.53 (3.79) 3.88*** 2 08
†
1.35
Arousal to Unpleasant Pictures (IAPS) 5.66 (2.28) 4.87 (2.56) 3.88 (2.63) 4.74 (2.78) 1.95 < 1 1.28
Note. Total, Narcissism, and Impulsivity score come from parental report of the Antisocial Process Screening Device (APSD). Callous-Unemotional is a composite of
items from parent reports of the APSD callous-unemotional traits scale and the Strength and Difficulties Questionnaire (SDQ) prosocial behavior scale. HIA
(Hyperactivity) and CP (Conduct Problems) come from teacher report on the SDQ. IAPS = International Affective Pictures System. Cont. 1 = contrast comparing
mean non-HIA-CP to HIA-CP; Cont. 2 = contrast comparing mean HIA-only to HIA-CP; Cont. 3 = contrast comparing mean CP-only to HIA-CP. Type I error was
maintained at a = .05 for all pairwise comparisons using Dunnett’s procedure. t-values are based on 486 (APSD), 456 (Callous-Unemotional), and 599 (IAPS)
degrees of freedom.
* p < .05; ** p < .01; *** p < .001;
†
1-tailed test, p < .05.

Michonski and Sharp Child and Adolescent Psychiatry and Mental Health 2010, 4:24
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children were not found to report experiencing the low-
est degree of arousal in response to the pictures. Rather,
the CP-only group report ed less arousal than did the
HIA-CP group. When considering the effect of CP
regardless of standing on HIA, children elevated in CP
traits reported significantly lower arousal to unpleasant
pictures than did children low in CP: F(1, 206) = 12.51,
p < .001.
These findings raised the possibility that HIA was
actually functioning to protect children high in CP
against reduced emotional reactivity. In order to further
explore this possibility, we conducted an exploratory
hierarchical regression analysis to consider whether HIA
may moderate the relation between CP and arousal rat-
ing. In step 1, HIA and CP were entered into the model.
In step 2, the interaction term (HIA×CP) was entered.
Both predictor variables (HIA and CP) were centered in
order to reduce nonessential multicolinearity [50]. As
shown in Table 3, resul ts revealed that CP emerged as a
significant predictor of arousal (B = 25,p < .05), while
HIA did not (B = 05, n.s.). Of greater interest, the
interaction term (Step 2) was also significant (B =.04,
p < .05), albeit the effect size for the model was small
(R
2
= .05). Even so, the direction of the moderati on
effect is interesting, as revealed by the plotti ng of the
interaction (Figure 1). Probing and plotting of the inter-

action followed the conventions recommended by Aiken
and West [50]. For testing of simple slopes, high and
low conditional values of the predictors were chosen as
the 90
th
and 50
th
percentile, respectively. The simple
slope of arousal regressed on CP was significant at both
levels of HIA. As depicted in Figure 1, the magnitude of
the negative association b etween CP and arousal ratings
was weakened at higher levels of HIA
3
.
Discussion
The objective of the current report was to revisit
Lynam’s [1,5] operationalization for capturing the fledg-
ling psychopath. This model contends that the future
psychopath is most likely to emerge from within a sub-
group of children elev ated in both HIA and CP. In
keeping with Lynam [5], we tested this model by
comparing children designated into four groups based
on their status with respect to HIA and CP . Specific ally,
we were interested in whet her high HIA-CP children
would resemble the adult psychopath in terms of the
core affective and i nterpersonal personality features
associated with psychopathy. These features were
assessed using parental reports of psychopathic-like
traits and using subjective emotional reactivity in
response to unpleasant, emotionally-laden pictures. As

such, the results of our study cannot be attributed to
shared method variance.
Overall, we did not find support for Lynam’smodel.
The primary dimension of psychopathic-like traits by
which the HIA-CP children were distinguished from the
other groups was impulsivity. However, with regard to
callous-unemotional and narcissistic traits, the HIA-CP
was indistinguishable from the CP-only group. Thus,
HIA-CP children did not appear the most psychopathic-
like in terms of the core affective and interpersonal
traits. The link with impulsivity is consistent with
Lynam’s [5] f indings on laboratory tas ks. Lynam found
significant differences between the HIA-CP and CP-only
groups on tasks involving delay of gratification and a
neuropsychological task requi ring attention and concen-
tration to perform sequences of complex behaviors.
Impulsivity may be an important dimension of psycho-
pathy [51,52]. However, it is doubtful that anyone would
argue for the sufficiency of impulsivity in distinguishing
youth at risk for psychopathy.
Further difficulty for Lynam’s model emerged with
respect to emotional reactivity to unple asant pictures.
Namely, the HIA-CP children did not self-report
experiencing the lowest level of emotional reactivity, as
would be anticipated if they were truly the most psy-
chopathic-like. In fact, the HIA-CP group did not
differ significantly from any of the other groups. When
the association among HIA, CP, and emotional reactiv-
ity was explored using a regression approach, HIA
actually showed a softening effect upon the relation

between emotional arousal/reactivity and CP, as evi-
denced by a significant HIA by CP interaction. High
levels of HIA appeared to protect high CP children
from exhibiting affective underarousal.
Other studies have reported a similar effect for HIA.
In a study of incarcerated adolescents, Sevecke, Kosson,
and Krischer [53] examined the effect of ADHD and CD
symptoms upon psychopat hic traits, assessed using the
Psychopathy Checklist-Youth Version (PCL-YV). Inter-
estingly, for boys, although ADHD did exhibit significant
bivariate relations with the PCL-YV total and four
dimensional scores (interpersonal, affective, lifestyle, and
antisocial), these effects remained significant only for
the antisocial dimension when CD was added to the
regression model. Additionally, with the exception of
Table 3 Hierarchical Regression of Arousal to Unpleasant
Pictures on HIA and CP
Bsr
2
R
2
Step 1 .04
HIA 05 .00
CP 25* .02
Step 2 .05
CP×HIA .04* .01
Note. HIA (Hyperactivity) and CP (Conduct Problems) come from teacher
report on the St rength and Difficulties Questionnaire (SDQ).
* p < .05.
Michonski and Sharp Child and Adolescent Psychiatry and Mental Health 2010, 4:24

/>Page 6 of 9
ant isocial traits, no synergistic effects were observed for
ADHD and CD in predicting psychopathic traits
4
.In
another study, Loney et al. [17] examined the impact of
both CU traits and impulsivity upon the processing of
emotionally-laden words in a sample of low to moderate
at-risk youth. They found that, while CU traits were
associated with slower reaction times for recognition of
negatively valenced words, HIA was associated with fas-
ter recognition of negatively valenced words. These find-
ing do not suggest a prominent role for HIA symptoms
in contributing to what many regard as a crucial compo-
nent of psychopath y–i.e., deficient affective experience
[6,7,54]. In Loney et al. [17], results suggest ed that HIA
is actually associated with greater reactivity to negative
emotional stimuli–a finding which would appear to run
counter to reports in which psychopathy has been asso-
ciated with decreased responsiveness to negatively
valenced emotional stimuli [12,14].
The present study, along with these prior findings
[17,53], calls into question the utility of prioritizing the
combination of HIA and CP for delineating a subgroup
most at risk for emerging psychopathic personality. The
fact that some studies have demonstrated a more persis-
tent pattern of antisocial behavior in youth with comor-
bid ADHD and CD appears therefore to be primarily
due to the increased levels of conduct problems in this
comorbid group, rather than the influence of ADHD

symptoms per se [6]. An alternative and more direct
approach to capturing a childhood analogue of adult
psychopathy makes t he affective and interpersonal fea-
tures more central (for reviews see [6,52,55,56]). Barry
et al. [25], for insta nce, found that, in addition to HIA
and CP, CU traits were necessary to distinguish a sub-
group of psychopathic-like children who showed a pre-
ference for thrill and adventure-seeking activities and
exhibited a reward-dominant response style on
laboratory tasks. Their findings suggested that Lynam’s
subty ping approach may designate an overly broad, per-
haps heterogeneous subgroup of children [57], especially
against the background of studies showing that a sub-
stantial number of children with childhood-onset con-
duct problems also exhibit co-occurring ADHD [58].
Therefore, this subtyping may not designate a group
that is very distinct from the broader group defined by
an early age of onset [59]. In contrast, there is now an
impressive body of evidence to suggest that the interper-
sonal and affective features originally described by
Cleckley [7] as the hallmark of the psychopathic person-
ality may better delineate a subgroup of antisocial youth
resembling the “fledgling psychopath.”
Another possibility is that the model advanced by
Lynam [1] is more inclined to identify children at risk
for developing a different form of antisocial/psycho-
pathic personality from the traditional conceptuali zation
[7]. Psychopathy has a long history of being viewed as
consisting of various forms and subty pes. Karpman [60]
was first to distinguish between primary and secondary

psychopathy. Primary psychopaths are more in keeping
with the Cleckleyia n view of psychopaths as cold, cal-
lous, manipulative, and egocentric, whereas secondary
psychopaths are viewed as neurotic and impulsive, their
antisocial behavior stemming from emotional conflict.
Perhaps Lynam’s HIA-CP children are at greater risk for
this latter type.
Strengths and Limitations
Our study presents several limitations that should be
noted. For one, the controversial practice of applying
the label of “psychopathy” to chi ldren [61,62], especially
a c ommunity sample of children, deserves comment. In
line with other studies of psychopathy in community
samples [39,63-65] we operationalize psychopathy as
Figure 1 Interaction of Con duct Problems and Hyperactivit y on Arou sal Ratings. Note. HIA (Hyperactivity) and CP (Conduct Problems)
come from teacher report on the Strengths and Difficulties Questionnaire. High and low conditional values for the predictors represent the 90th
and 50th percentiles, respectively. * p < .05; ** p < .01.
Michonski and Sharp Child and Adolescent Psychiatry and Mental Health 2010, 4:24
/>Page 7 of 9
traits that lie on a continuous dimension, as opposed to a
categorical diagnosis. Research in community samples is
important because it provides the opportunity to identify
developmental pathways by which psychopathy may
develop in children and adolescents. Indeed, several
recent reviews of the psychopathy literature [57] have
called for more research in community samples. Not-
withstanding the advantages of using community studies
in this line of research, the number of children above
cut-off for conduct problems, hyperactivity, and both
comb ined was relatively small . For instance, less than 5%

of participants fell into the HIA-CP category. It is there-
fore important that the current findings be replicated in
more severe samples (e.g., clinical and forensic). A sec-
ond limitation relates to the fact that arousal level/emo-
tional reactivity was not directly measured. A more direct
probe of biological variables through skin conductance or
fMRI would therefore improve on the current study
design. Finally, the post-hoc nature of the regression ana-
lysis should be born in m ind when interpre ting the mod-
eration effect. Future research is necessary to evaluate
the robustness w ith which HIA ma y limit expression of
emotional underarousal in high CP children.
Conclusions
Despite these limitations, the current study makes an
important contribution in being one of the few studies
to explicitly revisit Lynam’s algorithm for identifying the
fledgling psychopath, and by suggesting that hypera ctiv-
ity may not actually facilitate emergence of core features
of psychopathy in youth. While our findings do not
directly speak to treatment issues for child psychopa-
thy–an area which remains understudied–they do con-
tribute to comparatively limited research on the factors
that may dampen or promote the development of psy-
chopathy. A s such, these findings may be helpfully
incorporated in the clinical conceptualization of HIA,
CP, and p sychopathy and how these dis orders may be
distinguished from one another.
Appendix 1: Footnotes
1
All but one of the contrasts (CP-only v. HIA-CP) sur-

vived controls for gender and IQ.
2
All but one of the contrasts (HIA-only v. HIA-CP
for CU traits) survived controls for gender and IQ.
3
The interaction term remained significant with
inclusion of gender and IQ as covariates.
4
Sevecke et al. [53] did find that ADHD uniquely pre-
dicted psychopathic traits (including affective traits) over
and above CD for girls, however.
Acknowledgements
CS was funded by a National Health Services post-doctoral fellowship at the
University of Cambridge at the time of data collection.
Authors’ contributions
As principal investigator on this study, CS collected the data. She also
consulted in the analyses and assisted drafting of the paper. JDM took the
lead on drafting the paper and carried out the analyses. Both authors read
and approved the final manuscript.
Competing interests
Neither of the authors has received reimbursements, fees, funding, or salary
from an organization that may in any way gain or lose financially from the
publication of this manuscript, either now or in the future. Neither of the
authors holds any stocks or shares in an organization that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future. Neither of the authors holds or are currently applying for
any patents relating to the content of the manuscript. There are no
nonfinancial competing interests (political, personal, religious, ideological,
academic, intellectual, commercial or any other) to declare in relation to this
manuscript.

Received: 28 June 2010 Accepted: 3 September 2010
Published: 3 September 2010
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doi:10.1186/1753-2000-4-24
Cite this article as: Michonski and Sharp: Revisiting Lynam’s notion of
the “fledgling psychopath": are HIA-CP children truly psychopathic-like?.
Child and Adolescent Psychiatry and Mental Health 2010 4:24.
Michonski and Sharp Child and Adolescent Psychiatry and Mental Health 2010, 4:24
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